Dr Afsana Bhuiya
Speaker key
AB Dr Afsana Bhuiya
IV Interviewer
AB Hi, my name’s Dr Afsana Bhuiya. I work for London Cancer as the GP improvement lead. My talk was about the quality improvement project on improving GP read coding and safety netting in the context of cancer. I also covered the QCancer risk assessment tool.
IV What is coding?
AB So coding is essentially a comprehensive list of terms used by healthcare professionals to document information about their patients. That could be things like treatment, diagnosis, investigations, so that it’s in a retrievable manner so the computer understands it.
IV Why is coding important?
AB Good standards in coding and safety netting are incredibly important to enhance patient safety. It allows up-to-date data on your patient to be connected so that it’s available at your fingertips, and also it’s regardless of how long you’ve known that patient, so any person can view the notes and be up-to-date.
IV How can GPs improve their coding?
AB The full recommendations are in the guide that I’ve written, which we’ll give you the details afterwards, but in essence it starts from about six or seven basic points. So the first one is ensure that all your consultations have a problem code on them and the problem code should be relevant, it should be up-to-date, and it should be linked appropriately. So an example of that would be, say for example you code cancer, you should ensure that that cancer diagnosis is always an active problem, it’s a clinical problem, and if it’s been coded before, it’s linked. If it’s not, it’s a new problem.
So I’d advocate the use of coding symptoms a lot more and this is particularly relevant in the current climate of early diagnosis in cancer and utilising QCancer more. You can do that as you’re heading the consultation, or you can do it within the consultation itself. It depends on how that consultation goes. The other things I would recommend are to ensure that you use other read codes, like the fast-track cancer, so when you’ve done a cancer referral, it’s coded so that then you can do a search for it and ensure that those people have been followed up. I would also advocate family history of cancer coding, things that we’d normally do like weight and smoke history. Fuller details can be found in the guide.
IV What is the QCancer risk assessment tool?
AB It’s a risk assessment tool that can give you a risk of your patient having a current yet undiagnosed risk of having cancer. It is just a risk. It doesn’t give you the diagnosis of cancer. It was compiled from collective data taken from GP databases across the UK and it was compiled by statisticians Hippisley Cox, a specific one for males and females.
IV How is it used?
AB It’s pretty simple. So all of the EMISWeb have been uploaded with the template, so if you’re in a consultation and you’ve put in all your data, you would then go to the template section, search for QCancer, upload the tool and then run it. It gives you a collective QCancer risk. On the right-hand side you would then click on the view button to give you a breakdown of the risk of having individual cancer. The important thing is not the collective risk; it’s the individual breakdown because ultimately that’s what allows you to make the decision. I would just add several other points here which is, when would you run it, and I would suggest we do that for cases of uncertainty. When you have a bond or a two-week cancer referral it’s probably not that prudent to do it; you’ve made your decision. It’s more for the uncertainty.
The other thing I would add about it is, what’s the evidence for it? The evidence at the moment for running a QCancer risk assessment tool is that it enables the GP to think about the risk of cancer and the diagnosis of cancer a lot more. We don’t yet have enough strong evidence to say that it improves early diagnosis, but by us GPs utilising it more, we can have that information. And it ties in so much with coding and safety netting because if you don’t read code symptoms and risk factors like smoking and family history, the QCancer risk assessment tool is invalid.
IV What is safety netting?
AB So safety netting was a concept introduced into the GP consultation by a chap called Roger Neighbour and it should be a central part of the GP consultation. In the context of cancer, it’s essentially a process of monitoring patients at low risk, but not of no risk of having cancer, and actively monitoring them.
IV Why is it important?
AB Safety netting is incredibly important because it can go wrong and very badly wrong. The big bodies like Cancer Task Report and NICE guidance had highlighted how it’s important that GPs have rigorous systems for safety netting, and we know at present that we don’t have that. There’s no agreed consensus for it and so the guide and my talk was about how do we get our systems up to a level where we’re doing it really well.
IV How can GPs improve their safety netting?
AB I think fundamentally it’s to understand that safety netting is a core process of the consultation, and it’s comprehensive and detailed. I broadly divide it into two aspects: into the methodology, so that’s what means you use to safety net – verbal, written and electronic. The electronic methods are your most rigorous and auditable methods, so they’re the things like sending tasks, using EMIS to maximise on that, and then I would move into ensuring that GPs realise that they have a responsibility to safety net the whole consultation, so the GP/patient interaction versus the system processes.
So just to give you short examples, the GP and the patient could be giving them written information if you’ve done a two-week cancer referral, and the systems are to ensure that you have the correct address and phone number so that patient gets recalled appropriately. Obviously fuller details are in the guide.
IV Where can GPs find out more?
AB So I would direct them to the London Cancer website, so that’s londoncancer.org and you can get the full link on the details below. I’m also contactable via my London Cancer email, so and that’s particularly prudent if you want to find out about how to take part in the project.
3